Healthcare - Cure On The Move

Airports are magnets For social and economic development. Health centres at modern airports offer mouth-watering prospects of returns on investment and with good reason. Airports that intend to serve the world’s renewed economies in the years to come, plan for three to five-fold increase in passenger traffic. The number of passengers flying annually runs into millions while the number of people airborne at any point in time is equally humongous. There are cities in flight and cities at airports that never sleep. So can medical services ignore opportunities in airport cities? Not likely. In fact, there are also cities in the air. At about 35,000 ft, there is possibly greater access to world class medical care than on the ground.

In fact, at an airport one could plan in advance to spend a few hours on the ground or circumstances could pitch one into such a situation. One of those long postponed tests recommended by the personal physician could actually be taken, or that stress-busting, therapeutic ayurvedic massage, realignment of a painful back, harmonising one’s time-zones or consult a cardiologist—all within the time spent in an airport lounge. To get a bird’s eye view of how medical services are going head over heels trying to garner ‘medi-dollars’, it is important to note that medical support for the airline industry can work on two broad platforms—on board the airplane and on the ground.

On Board The Airplane

About 1,000 people die in flight every year while criss-crossing the skies. This works out to approximately one per million passengers and this is expected to increase in the years to come. Whilst a majority of these deaths are due to cardiac problems, the interesting point is that many of those who succumbed to cardiac episode, were well aware of the seriousness of their condition prior to boarding.

Out of sheer necessity or even by way of a good public relations exercise, an increasing number of commercial airplanes carry on board automated external defibrillators. But the extent to which cabin crew is au fait with the equipment and is trained for its use, in an emergency is open to question. If heart attacks are the major cause of in-flight fatality, they are only a fraction of medical emergencies encountered in flight. Neurological emergencies such as epileptic attack and cerebral stroke, deep vein thrombosis, stomach disorders and breathing problems are seen to occur frequently.

Two types of medical kits are carried on board an airliner: one for use by doctor from amongst the passengers and the other for use by a trained paramedic, nurse or an individual confident and experienced in administering first-aid. A newer version of in-flight medical attendance is air-to-ground telemetry using satellites. Any chosen nodal medical centre or the concerned e-doctor, wherever in the world he may be, can be approached for medical history and other details pertaining to the concerned patient.

The Airport Clinic

An airport dealing with high volumes of passenger traffic can and should logistically have an appropriately supported medical infrastructure. Most international airports have an integral medical facility that is open and functional round-the-clock to provide the first response to emergencies involving passengers, airport employees and visitors.

More importantly, the airport integral medical facility provides immediate response to aircraft accident related emergencies at the airport. As the medical centre of the airport, this clinic serves other purposes such as family medicine, public health (pandemic control duties), customs support (advising on illegal and unauthorised drugs) vaccinations and travel medicine guidance.

What is the manpower and service mix for such a facility? The following is the range of services that could be offered:

Aviation Medicine Services with charter to provide
• healthcare support and “fitness to fly” assessment for pilots and cabin crew with health problems,
• healthcare support and “fitness to fly” assessment for passengers reporting for flights with health concerns or developing health problems while in flight or while in transit,
• medical certification for international pilots based on the regulatory requirements of various civil aviation authorities, and
• telemedicine support for pilots dealing with passengers or crew on board needing medical care.

Occupational Health Services to support
• occupational health programmes for the airline aligned to global benchmarks and expectations, including but not limited to hearing conservation, chemical hazard control (including management of hazardous materials), control of biohazards (including prevention of transmission of infectious diseases on board aircraft) and ergonomics,
• integrated back-care programmes, in collaboration with occupational physiotherapists,
• treatment of occupational health problems, such as asthma and skin disease,
• occupational health seminars and education programmes, and
• Support for occupational health aspects of occupational safety and health accreditation, such as OHSAS 18001.

Family Medicine Services that will provide
• comprehensive healthcare needs of all members of the family including women, children and the elderly,
• presence of male and female doctors,
• supportive healthcare modalities, such as X-ray, ultrasound, hearing tests, vision tests, physiotherapy, cardiac assessment for screening (treadmill, 24-hour ambulatory blood pressure monitoring, 24-hour ECG monitoring and so on), and
• integrated wellness medical support and preventive medicine advice required by travellers, such as health screening and vaccinations/travel medicine consultations.

Education and Training solutions would involve
• conducting human factors training programmes for aircrew and ground crew, including but not limited to courses in humanperformance and limitations for aircrew,
• cockpit resources management,
• fatigue countermeasures for long haul and ultra long haul flying, human factors in ground maintenance operations and physical ergonomics for office workers,
• aviation first aid training to all aircrew,
• training of aircrew in use of automated external defibrillators for airlines equipping their aircraft with such device,
• occupational safety and health training packages—awareness of OHSAS 18001 certification issues and control of biohazards,and
• aviation physiology and aviation medicine indoctrination programmes for aircrew, including awareness of hypoxia, hyperventilation, decompression sickness, pressure changes and trapped gas disorders, spatial disorientation, situation awareness, fitness to fly, medication and flight safety.

Integrated Wellness Support require
• customised individual and community health screening programmes,
• comprehensive physiotherapy services, including occupational therapy for pain management and rehabilitation for early return to work, and
• specialised clinics for obesity, nutritional problems, yoga and ayurvedic massage, “stop-smoking”, fear of flying/anxiety clinics are some other offerings in the bouquet would complete the “dream team” of facilities.

Medical Support Services: An accredited pathology laboratory offering the widest range of blood chemistry and haematology tests, a state-of-the-art imaging services (CAT and MRI scans), cardiac lab with treadmill stress testing and Doppler Echo imaging, round-the-clock blood pressure and ECG monitoring would be essential and well utilised in the shortest possible time.